Behavioral couples therapy for substance abusers: where do we go from here?
Klostermann K., Kelley M.L., Mignone T. et al. Substance Use & Misuse: 2011, 46, p. 1502–1509.

Problem drinkers and drug users in a persisting if distressed relationship with a partner do better when the focus is at least partly shifted from the patient to working with the couple to foster sobriety-encouraging interactions. Benefits for patients and the broader society can be remarkable.

Summary
Of the psychosocial interventions available to treat problem alcohol and drug use, it could be argued that partner-involved treatments are the most broadly efficacious, not just in terms of substance use and relationship adjustment, but also other dimensions of public health significance including domestic violence and cost–benefit and cost-effectiveness.

Behavioural couples therapy is one of these approaches, based on the insight that distressed couples engage in mutual punishment rather than mutually rewarding behaviours which improve the relationship. Developed as a marital therapy, in the past three decades it has also been shown effective for alcoholism and drug problems.

The therapy assumes that substance use problems and intimate relationships are reciprocally related, such that substance use impairs relationship functioning, and severe relationship distress combined with attempts by partners to control substance use may prompt craving, reinforce substance use, or trigger relapse.

To break this vicious cycle and transform the relationship in to a positive force, the therapy aims to build support for abstinence and to improve relationship functioning. It features a 'recovery contract' which 'bans' mention of past substance use and fears of future relapse, and instead involves the couple in a daily ritual to reaffirm and reinforce the user's intention to that day stay drug-free/sober, together with techniques for increasing positive activities and improving communication. A calendar kept by the couple records their progress and 'homework' activities, providing a focus for therapy sessions. Towards the end a continuing recovery plan is agreed for how the couple will tail off therapy-associated activities. A usual requirement for the therapy is that the partner of the problem substance user does not themselves have the same sort of problem.